- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $104.71 / $104.71 / $104.71
| Facility | | $104.71 | $104.71 | $104.71 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $61.66 / $61.66 / $61.66
| Facility | TC | $61.66 | $61.66 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $40.74 / $58.88 / $117.49
| Professional | | $40.74 | $58.88 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $15.85 / $28.18 / $141.25
| Professional | 26 | $15.85 | $28.18 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $22.91 / $30.90 / $61.66
| Professional | TC | $22.91 | $30.90 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $31.62 / $41.69 / $67.61
| Professional | | $31.62 | $41.69 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $13.18 / $16.22 / $35.48
| Professional | 26 | $13.18 | $16.22 | $35.48 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $18.62 / $19.95 / $33.11
| Professional | TC | $18.62 | $19.95 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $36.31 / $36.31 / $36.31
| Facility | | $36.31 | $36.31 | $36.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.45 / $36.31 / $91.20
| Professional | | $14.45 | $36.31 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $40.74 / $83.18 / $158.49
| Professional | | $40.74 | $83.18 | $158.49 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $43.65 / $63.10 / $63.10
| Facility | | $43.65 | $63.10 | $63.10 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $36.31 / $38.02 / $38.02
| Facility | TC | $36.31 | $38.02 | $38.02 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $25.12 / $25.70 / $25.70
| Professional | 26 | $25.12 | $25.70 | $25.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.11 / $51.29 / $147.91
| Professional | | $33.11 | $51.29 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $13.18 / $28.18 / $70.79
| Professional | 26 | $13.18 | $28.18 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $18.62 / $25.70 / $72.44
| Professional | TC | $18.62 | $25.70 | $72.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $416.87 / $416.87 / $416.87
| Facility | | $416.87 | $416.87 | $416.87 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $234.42 / $234.42 / $234.42
| Facility | 26 | $234.42 | $234.42 | $234.42 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $251.19 / $251.19 / $251.19
| Facility | TC | $251.19 | $251.19 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $645.65 / $645.65
| Professional | | $194.98 | $645.65 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $512.86 / $512.86 / $512.86
| Professional | 26 | $512.86 | $512.86 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $323.59 / $346.74 / $346.74
| Professional | TC | $323.59 | $346.74 | $346.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $95.50 / $186.21
| Facility | | $51.29 | $95.50 | $186.21 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $61.66 / $61.66 / $61.66
| Facility | TC | $61.66 | $61.66 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $39.81 / $81.28 / $147.91
| Professional | | $39.81 | $81.28 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $15.85 / $33.88 / $91.20
| Professional | 26 | $15.85 | $33.88 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $23.99 / $48.98 / $81.28
| Professional | TC | $23.99 | $48.98 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $24.55 / $33.11 / $57.54
| Professional | | $24.55 | $33.11 | $57.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $27.54 / $64.57 / $138.04
| Professional | | $27.54 | $64.57 | $138.04 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $48.98 / $89.13 / $186.21
| Facility | | $48.98 | $89.13 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $54.95 / $173.78
| Professional | | $32.36 | $54.95 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $13.18 / $28.18 / $75.86
| Professional | 26 | $13.18 | $28.18 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $18.62 / $25.70 / $72.44
| Professional | TC | $18.62 | $25.70 | $72.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $21.88 / $33.11 / $54.95
| Facility | | $21.88 | $33.11 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $40.74 / $63.10 / $154.88
| Professional | | $40.74 | $63.10 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $17.38 / $31.62 / $75.86
| Professional | 26 | $17.38 | $31.62 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $23.99 / $30.20 / $87.10
| Professional | TC | $23.99 | $30.20 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.92 / $33.88 / $66.07
| Professional | | $26.92 | $33.88 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $11.22 / $13.49 / $26.30
| Professional | 26 | $11.22 | $13.49 | $26.30 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $15.49 / $20.42 / $38.90
| Professional | TC | $15.49 | $20.42 | $38.90 |